One Afternoon Late in the Summer of 1998, I Found Myself

I NTRODUC TION

ne afternoon late in the summer of 1998, I found myself sitting on the long front porch of a weathered student Ohouse in Portland, Oregon. I was nineteen years old and had just returned to town to start my second year of college. !e porch I was sitting on belonged to the house that would be home that year to my good friend Kate. I had spent the day helping her move in, relaying loads of clothing, books, and LPs from her car, across the yard, up a staircase scu"ed by decades of similar use, and into her new room. At 5:00 #.$., exhausted, we %opped onto the row of mismatched seating that looked out over the cracked, gray street. Moving o" campus was a sophomore rite of passage at our school, and I considered Kate’s snagging a room in this particular house to be a promising social development. Her new housemates included some of the students on campus I’d looked up to most the year before— smart, fashionable, con&dent women who seemed as advanced and distant to me then as I remembered high school seniors seeming when I was in eighth grade. As they <ered in and slowly took their own seats around us, I stretched in my thrift- store lounger and smiled. Simply sharing

Zoloft_i_xxiv_1_312_4p.indd 11 3/21/12 4:22 PM their porch with them felt glamorous, like a good omen for the year to come. Late- afternoon sun gilded the %oorboards, as our conversation meandered through the familiar topics of professors, classes, boys, and books. Kate headed inside to organize her room, and Lauren mixed a pitcher of Amaretto sours for those who were left. And then the thing happened that has &xed this afternoon in my mind for more than a decade. Casually, and in the abstract, someone mentioned antidepressants. !e comment sent a ripple through me. I had been taking an antidepressant since the year before, when a series of anxiety at- tacks had led me to the student health center, where I’d quickly been diagnosed as depressed and given a prescription for Zoloft. Medication seemed to have helped; the billowing dread that had come upon me during my freshman fall had dissipated, and I’d &nished out the year with good grades, friends, a boyfriend, new interests. Still, I felt uneasy about my chemically assisted recov- ery. !ere was something creepy about taking a mind- altering drug each day, and thinking of myself as a person with a mental disorder was dispiriting in its own right. Aside from a few close friends, I hadn’t told anybody I took them; I &gured other people would &nd the fact as o"- putting as I did myself. I still don’t know what it was that made me open my mouth that day. Maybe I was lulled by the sunshine, the strange drink, or the urge, in such exalted company, to say something that would call attention to myself. “I take those,” I blurted and instantly looked down at my hands, wondering whether I’d just e"ected my own social excom- munication. When I managed to raise my eyes again, though, I saw that heads up and down the row were nodding slowly.

xii INTRODUCTION

Zoloft_i_xxiv_1_312_4p.indd 12 3/21/12 4:22 PM “I do too,” said Helen. “!ey put me on Prozac last year,” Lauren added. And on we went. !ere were seven girls on that porch. Every single one of us, it turned out, was or had been on antidepressants. In the moments afterward, we looked out toward the street, where a patch of weeds cast a long shadow across the pavement. “!is is really weird,” somebody said, and the rest of us mumbled assent.

AS I COLLECTED myself in the silence, I felt two things at the same time. !e &rst was a wave of relief so large and pure it almost knocked me over. All year, taking medication had made me feel uneasy. !e pills imparted strength and calm, but they also raised tough questions— Am I crazy? Will I need these forever? Am I really myself when I take them?— that I could neither answer to my satisfaction nor successfully push from my mind. Learn- ing that I wasn’t alone in using medication soothed the sense of alienation that had been the pills’ most notable side e"ect. If people as poised and admirable as Kate’s housemates could also take antidepressants, maybe there was still hope for me. But if learning that I had so much company on the antidepressant bandwagon was comforting in one way, it was disorient- ing in another. I had been taught to think of antidepressants as a treatment for depression, which I understood as a real illness, something rare and serious. !e fact that all seven of us could be taking medication strained the limits of my sense of prob- ability. Were we all, in some meaningful way, mentally ill? Or were antidepressants being given out not for true depression but precisely for the ordinary angst that I’d been told was so di"erent from it? If we all had this experience in common, why had we

INTRODUCTION xiii

Zoloft_i_xxiv_1_312_4p.indd 13 3/21/12 4:22 PM not found out about it until now? I felt a little dizzy, and newly suspicious. What exactly was happening here? Before that moment, taking antidepressants had felt like the most intimate and personal thing in the world to me. It was still personal, of course, but I began to see then that it was also more than that. Medication was individual, but also social; it was part of our stories, but equally part of the story of a time and place. In a way that I didn’t yet fully understand, our lives had intersected with something larger than themselves. It is strange, as a young person, to realize that you have lived through something that can be considered a real historical change, but that’s exactly what we had done. When I was a child, in the early 1980s, taking psychiatric medication was decidedly a fringe phenomenon. Prozac came onto the market in 1987, the year I was eight. !e &rst member of a family of drugs called SSRIs (for “selective serotonin reuptake inhibitors”), it quickly became the leading edge of a psychopharmaceutical revolution. !roughout the 1990s and 2000s, Americans grew ever more likely to reach for a pill to address a wide variety of mental and emotional problems. We also became more likely to think of those problems as a kind of disease, manifestations of an innate biochemical imbal- ance. Depression, social anxiety, obsessive- compulsive disorder, and the like went from being strange clinical terms or scrupu- lously hidden secrets to constituting acceptable topics of cocktail party conversation— talk that was often followed up by chatter about the new miracle drugs for despair. Statistics bear out the sense of changing habits. Antidepres- sants began to climb steadily in popularity after Prozac’s introduction, eventually becoming a truly mass phenomenon. By 2005, SSRIs had surpassed blood pressure medications to

xiv INTRODUCTION

Zoloft_i_xxiv_1_312_4p.indd 14 3/21/12 4:22 PM become the most- used class of drugs in America,1 with 10 percent of adults taking them in any given month.2 By 2008, that &gure had bumped up to 11 percent.3 While they were becoming part of the fabric of American life, psychopharmaceuticals also became, with much greater frequency, a part of American youth: in 2008, 5 percent of adolescents aged twelve to nineteen took an antidepressant.4 !e same year, another 6 percent of twelve- to- nineteen- year- olds used psychostimulant medication for ADHD.5 Nothing has changed since that moment on the porch, I sometimes think, except that I’m not surprised anymore. Antidepres- sants are part of the story of my generation, an invisible but very real strand woven through our collective experience. Psychiatric medication saturated the country during our childhood and adolescence, and for many of us, the involvement became personal. In our twenties and thirties now, with birthdays that fall from the mid- 1970s to the start of the 1990s, we are members of the &rst generation to have literally grown up on psychiatric medications in signi&cant numbers. And sometimes those numbers still overwhelm me. Anti- depressant use saturates certain populations more than others, which may help explain why antidepressants have often struck me as being even more ubiquitous among my peers than the above &gures suggest. Women take them at higher rates than men, a di"erence that emerges in early adolescence; a recent sur- vey found that 16 percent of women use antidepressants, com- pared to 6 percent of men.6 White adolescents are more than &ve times as likely to use an antidepressant than black adolescents, and more than twice as likely as Latino adolescents,7 ra- cial disparities that also hold true for adults.8 Personally, I can’t

INTRODUCTION xv

Zoloft_i_xxiv_1_312_4p.indd 15 3/21/12 4:22 PM remember the last time I shared the topic of this book with a group of more than three twenty- or thirtysomethings without eliciting someone’s own medication story, often from the person I least expected. Not long ago, I was talking to a male friend, age thirty- &ve, who exclaimed, only half in jest, “I’ve never known a girl who wasn’t on antidepressants!” I must have come a long way from Portland, because I knew exactly what he meant.

THIS IS A book about what it’s like to grow up on antidepressants. It attempts a faithful description of an activity that has become remarkably common— using antidepressants as a teenager or young adult— but still engenders intense, complicated, and often con%icted feelings, both in the young people who do it and the adults who are involved in their care. Advertisements and re- ductive media stories often portray antidepressant use as simple. Depression is a disease “like diabetes,” the story goes, and the appropriate treatment is equally straightforward: &nd a doctor, locate a pill, take it, and be well. Further soul- searching about it isn’t just unnecessary, it’s likely to be counterproductive. But the truth is that even when the medications work just as they are supposed to, taking antidepressants is an experience that can feel profound. Rightly or wrongly, antidepressants command power- ful emotions; they can lead people to examine their deepest as- sumptions about themselves and the world. It is also an experience that can be substantially di"erent for a young person than it is for an adult. Ever since the early 1990s, much of our cultural conversation about antidepressants has revolved around questions of selfhood. Adults who take antidepressants have been known to worry whether the medication is altering their habits, their proclivities, or their outlook on

xvi INTRODUCTION

Zoloft_i_xxiv_1_312_4p.indd 16 3/21/12 4:22 PM life— whether it is in some way changing the very people they are inside. Conversely, adults who are happy with their treatment often speak of antidepressants as facilitating a return to au- thenticity; they say that medication “turned me back into my old self again.” Indeed, the notion that depression distorts the true self and that antidepressants merely restore what was there all along has often been invoked against the fear that by taking antidepressants, we might somehow be betraying our true natures. But that belief in particular is one that people who start medication young cannot fall back on. Worries about how antidepressants might a"ect the self are greatly magni&ed for people who begin using them in adolescence, before they’ve developed a sta- ble, adult sense of self. Lacking a reliable conception of what it is to feel “like themselves,” young people have no way to gauge the e"ects of the drugs on their developing personalities. Searching for identity— asking “Who am I?” and combing the inner and outer worlds for an answer that seems to &t— is the main devel- opmental task of the teenage years. And for some young adults, the idea of taking a medication that could frustrate that search can become a discouraging, painful preoccupation. When I &rst began to use Zoloft, my inability to pick apart my “real” thoughts and emotions from those imparted by the drug made me feel bereft. !e trouble seemed to have everything to do with being young. I was conscious of needing to &g- ure out my own interests and point myself in a direction in the world, and the fact of being on medication seemed frighteningly to compound the possibilities for error. How could I ever &nd my way in life if I didn’t even know which feelings were mine? For me, as for many members of my generation, the process of growing up became linked to the practice of taking medication

INTRODUCTION xvii

Zoloft_i_xxiv_1_312_4p.indd 17 3/21/12 4:22 PM and thinking about mental disorder. In aggregate, my antidepressant story is not dramatic. By the standards of the sensational medication memoirs that I began to track down and devour in college, in an attempt to better understand what I was going through, it is positively vanilla. After the moment on Kate’s porch, though, I began for the &rst time to think that my story might have an interest and a relevance of its own— not because it was so very unique, but precisely because it wasn’t. Before that day, I’d been interested in tracking my experience on medication for personal reasons, but afterward I redoubled my e"orts; I literally started to take better notes. I ended up using antidepressants for most of ten years, and the story of that unfolding relationship—during which my perspective on myself, on medication, and on the nature of health all changed signi&cantly—is part of what structures this book. Realizing that other people my age used antidepressants too whetted my appetite to hear their own stories. I wanted to know whether others felt as ambivalent about antidepressants and about the diagnoses that came with them as I did, whether medication had raised the same di'cult questions for them as it had for me. !e handful of casual conversations that I had about these topics over the years always fascinated me. In order to write this book, I interviewed forty people, ranging in age from eighteen to forty, about their own experiences growing up on antidepressants, and I corresponded by e- mail with about a dozen more. Talk- ing to them revealed common themes in the experience of using psychiatric medication as a young person and turned up many points of contact as well as divergence from my own story. !eir words and points of view are incorporated throughout the book. Part of the reason why the moment on the porch stayed with

xviii INTRODUCTION

Zoloft_i_xxiv_1_312_4p.indd 18 3/21/12 4:22 PM me for so long was the sheer force of the relief it brought me to connect, in person, with other people whose experiences mir- rored my own. !ough times have changed and it’s hard to imagine, today, any young person believing that they’re alone in taking a psychotropic medication, my research con&rmed that medication use is still not something that people talk about with each other in- depth or regularly. But there is understanding to be gained in such conversations; partaking in stories of one another is one of the purest and most elemental forms of comfort available to us in our sped- up, surface- happy world. When I con- ducted the interviews for this book, a number of the people I talked to thanked me. !ey told me that they didn’t speak about these topics very often, and that they were excited to hear what others had to say. One of my highest hopes for this book is that it will in some small way replicate the e"ects of that moment on the porch in Portland. I hope that people who take or have taken antidepressants will &nd these stories recognizable, thought pro- voking, and ultimately a'rming, and that friends and family will feel helped to a greater understanding of an experience that can be hard to put into words. I also hope that this book will contribute something to a debate that has unfolded over the course of the psychopharmaceutical revolution. !ere is no question that the last twenty- &ve years have seen a great change in terms of how we conceive of emotional and behavioral problems, which we’ve moved decisively towards classifying as biochemical disorders. !ere is a lively cultural argument going on now about whether that’s been good or bad. Critics of the shift contend that the “medicaliza- tion” of what were once regarded as negative feelings or nui- sance parts of life has harmed us, that mental disorder is now

INTRODUCTION xix

Zoloft_i_xxiv_1_312_4p.indd 19 3/21/12 4:22 PM overdiagnosed and psychiatric medications are overprescribed. !ey argue that we’ve moved beyond &ghting legitimate psychiatric illness and have begun to wage pharmaceutical warfare on ordinary sadness— a war that has given undue power to “ex- perts,” lined the pockets of pharmaceutical companies, and left the rest of us feeling enfeebled, more ill than we truly are. Propo- nents argue that the revolution hasn’t yet gone far enough. !ey claim we’ve made headway in reducing the stigma surrounding mental disorder but that there’s work yet to be done, and contend that emotional problems are still, on balance, undertreated. !is grand debate about the value of our turn to medication marches forward though a series of more practical ones. Prominent &g- ures argue about whether antidepressants are “truly” e"ective, or merely fancy placebos, and the question about a possible link between antidepressants and suicidal behavior in children and adolescents is still open. !is book won’t settle those debates, but it does speak to them. Twenty- &ve years after the introduction of Prozac, we are still collectively attempting to &gure out what an appropriate use of medication would look like, in our culture and in our individual lives. We are trying to &gure out what our sadness and pain mean— if they mean anything at all— and when they attain the status of illness. We’re trying to &gure out when to turn to pills, when to go another route, and how we might be able to tell. !is book isn’t a polemic or a self- help title. It can’t tell you whether you need help or what kind to get. But it does believe that good answers to the big questions about medication are likely to proceed from careful attention to the actual experiences of the people who have faced them. Stories like the ones collected here may help us to a more realistic assessment of what

xx INTRODUCTION

Zoloft_i_xxiv_1_312_4p.indd 20 3/21/12 4:22 PM antidepressants can and can’t do, when they are a good idea, and when the detriments might outweigh the bene&ts. And it is in that spirit that I o"er the story of my own decade of antidepressant use and how it intersected with my path to adulthood, and the stories of many of the forty- plus people who spoke to me about the same thing.

INTRODUCTION xxi

Zoloft_i_xxiv_1_312_4p.indd 21 3/21/12 4:22 PM Zoloft_i_xxiv_1_312_4p.indd 22 3/21/12 4:22 PM 1 | T H E DIAGNOSIS

o describe how I got started on antidepressants, I could reach way back. I could tell you about my earliest memo- Tries, or give background on my parents or even my grand- parents. But the best place to start is the summer of 1997 in Arlington, Virginia, a hot one even by the standards of the Wash- ington, D.C., area. In the suburbs, the air itself often seemed to sag around street level, holding the smells of grass clippings, car exhaust, and barbecue in its thick embrace. People moved slowly, and once in a while someone made the old crack questioning the wisdom of our founding fathers’ decision to build their capital city on a malarial swamp. !at summer I was seventeen and, like other seventeen- year- olds I knew, I used my car to get places. I had access to an ancient, bright orange Volvo sedan that had belonged to my grandfather, which I loved almost as &ercely as the act of driving itself. Most days, I drove to the co"ee shop where my best friend, Sarah, and I both worked. Early- morning drives to the shop were the best, before 6:00 (.$., the streets empty, the sun already blazing up like a pink rubber ball over the rolling hills of Arlington. After work I drove to Sarah’s house, took myself on

Zoloft_i_xxiv_1_312_4p.indd 1 3/21/12 4:22 PM shopping errands at strip malls lined with big- box stores, or went to the parklike cemetery to read or write. Sometimes at night we would drive just for the sake of driving. We’d aim Sarah’s Cut- lass Ciera down the George Washington Parkway, which runs alongside the Potomac River. I liked the way the lights of the city’s bridges seemed to %oat like jewels in the water, the humid night air pouring in the windows, the feeling of the road ahead all clear.

SCHOOL HAD ENDED in the middle of June, an occasion marked by a graduation ceremony complete with tears, hugs, yearbooks to sign, and a pool party afterward. My parents surprised me by giving me a camera as a graduation present, and in the weeks that followed I used it to take pictures of every familiar thing: my mom’s tuna &sh salad, glistening with red onion; my father standing in the kitchen, drinking co"ee; my younger sister at the diner, saying something funny, mouth open, a cigarette in her hand, her blue eyes big and bright. I added older pictures I’d taken of friends— Huey, Josh, Ellie, and Anne, even a couple of my ex- boyfriend, Scott— and pressed them all between the pages of a small photo album to take away to college at the summer’s end. It was hard to imagine a world past school and Arlington. Some people hate high school, but I hadn’t. !e small, public magnet school I’d attended since sixth grade had suited me well; at best, it had felt like a real community, and I’d been that rare kid who is happier and more social as a teenager than as a child. I had even picked my future college, a small liberal arts school in Oregon, because its culture reminded me of my old school in many ways. Still, the idea of really leaving H- B Woodlawn and

2 COMING OF AGE ON ZOLOFT

Zoloft_i_xxiv_1_312_4p.indd 2 3/21/12 4:22 PM the life I’d known behind made me feel sad. Sad, and though I tried to block it out with excitement, more than a little scared. At &rst, fear and anxiety came in the guise of nostalgia. I decided to spend the summer commemorating everything I’d loved about the past six or seven years. I would revisit every place I’d ever been to, go to every restaurant or park or co"ee shop I’d ever liked, one last time, return to the scene of every milestone or event or &ght that had seemed important. I would soak it all in thoroughly, &x it in my mind forever, revel in the bittersweet in- tensity of a phase of life nearing its end. And somehow, I imagined, that would make me ready to face what was next. Scott had broken up with me the week after graduation. He walked from his house down the block over to mine, and we sat on my parents’ gray couch and talked about how it wasn’t working out. In one sense, the breakup was no big deal. We had barely even seen each other all spring. When I was honest with myself, it was easy to see that it was right for it to end. We had drifted together during early senior year when we were both working on a school play. But we had always been an odd couple. Scott was straight edge, I wasn’t; he did wholesome things like improv theater and Model United Nations, while I read Beat poetry and sneaked cigarettes in the parking lot behind the school. Beyond a shared sense of mild outsider status, we had never understood each other well. By dumping me he was only giving voice to what was already obviously true. Still, the breakup created a space that seemed to attract all kinds of negativity into itself. My mind began to curdle, and my nostalgic agenda for the summer started to take on a nihilistic edge. I didn’t want to do anything new or meet anyone I didn’t know already. What’s the point? my mind would ask. We’re all just

THE DIAGNOSIS 3

Zoloft_i_xxiv_1_312_4p.indd 3 3/21/12 4:22 PM leaving anyway. Abstractly, I knew that leaving home for college meant a fresh start, a rebirth. But most of the time I couldn’t see past the part that felt like dying, everything I’d known collaps- ing in on itself like an exploded star. On the night of my eighteenth birthday, I walked into the darkened playing &eld behind my high school, a few blocks from my house. !e air was warm and sultry, shorts and T- shirt weather even well after dark. Grass and clover tugged at my ankles. I sat on the split- rail fence, held my face in my hands, and cried. Whatever life was, I wasn’t sure I was up to it. Normal things had begun to feel unbearably poignant: the last time I hauled a heavy garbage bag of co"ee grounds out to the Dumpster in the sweltering parking lot behind work, the familiar action, never to be repeated, almost reduced me to tears. !e future seemed unimaginable; I felt like I was about to be pushed into the Coliseum with a bunch of wild animals. Was I ready? Could I possibly be ready? Would I ever do the things I wanted to do, would I ever be normal? Would anyone ever love me? Dear god, would I ever get laid? It all seemed terribly impossible to visualize. When I look back from today on my mood that summer, it’s not hard to see reasons why I felt unsettled. I think that I was suf- fering from lack of daily structure, and a straightforward fear of leaving home, probably compounded by a lack of self- con&dence. But from the inside, it didn’t seem clear or understandable at all. I didn’t feel afraid of school, exactly; I felt %awed— in some way so strange, complete, and unique that I couldn’t even fathom it, let alone do anything on my own behalf. I exaggerated in my mind how wonderful high school had been. !e truth was that after all those years I was sick of it. I needed new challenges and

4 COMING OF AGE ON ZOLOFT

Zoloft_i_xxiv_1_312_4p.indd 4 3/21/12 4:22 PM new people. But most of the time I had no access to those yearn- ings. All I felt was a penetrating fear of loneliness, and deep grief for all that I would leave behind. In the evenings I consigned my fears to the pages of my journal. In purple pen, I wrote: I’m scared shitless of going to college, but this is such a big subject it’s hard to get started. I go crazy. But how to be speci!c? Wild moods. Frantic, or complete apathy. And a few days later: It’s when I think about all the things left to do in life— big and small things equally— that I think I can’t go on. Everything makes me want to throw up today.

SARAH DIDN’T UNDERSTAND my frame of mind. She seemed to be %ourishing: working at the co"ee shop, getting to know all the patrons, dating one of them, and then another. She couldn’t be happier to &nally be free of high school. With her long brown hair and her nose ring and her newfound aura of indomitability, she looked beautiful. “You need to relax,” she said to me one afternoon. We were sitting in her bedroom, me on the bed, Sarah in a desk chair beneath her enormous Pink Floyd poster. “!is is a summer for having fun,” she continued. “We did it. We’re on top of the heap. We’re going to college. !is summer is our reward.” “I know,” I said. “I know! I shouldn’t be taking things so seriously.” Sarah’s point of view sounded reasonable and wise; I just couldn’t make it stick in my own case. “We need to get you some fun,” she said. “You should have a summer %ing.” “What’s the point of a summer %ing? We’re all just leaving.” “!at’s exactly the point,” she said, taking a sock- ball from the dresser and throwing it at me. “You’re hopeless!”

THE DIAGNOSIS 5

Zoloft_i_xxiv_1_312_4p.indd 5 3/21/12 4:22 PM “I’m not hopeless!” “Yes you are,” she said, rolling forward in her desk chair, then hauling her body upright. “Come on. Let’s go get some home fries.”

YET FEELING BAD wasn’t the whole story of that time. Looking back, it almost seems as if there were two summers, simultaneous and nonintersecting. !ere was the summer I felt bad in, and there was the beautiful, intense summer. !e summer in which Sarah and I rocketed down the George Washington Parkway in her car after midnight, blasting the Smashing Pumpkins, deep in the crazy love that only high school best friends can have for each other. !e summer in which I devoted my afternoons to writing a novella that was meant to weave my observations about the people and places I’d known in high school into a kaleido- scopic whole. !ere are bubbly, excitable entries in my journals that parallel the angry, mournful ones. In August, I went to see Scott in a production of A Midsummer Night’s Dream, and we talked afterward and it felt good, like closure. It was excellent to be through with high school. At certain moments, that feeling that Sarah talked about would settle, drift down on us like valedictory snow. We’d made it. Hail to us. Was I depressed? It seems strange to say, but that is not a question I asked myself then. If I had graduated high school in 2007 instead of 1997, it seems inevitable that I would have asked myself the question, or that someone else would have asked it for me. How would I answer? No— I wasn’t depressed, exactly, because depression is supposed to go on for weeks, unbroken, and no feeling I had that summer lasted for any length of time. Were my moods abnormal? It’s hard to say. I did seem to be taking the

6 COMING OF AGE ON ZOLOFT

Zoloft_i_xxiv_1_312_4p.indd 6 3/21/12 4:22 PM transition harder than my friends were. But then, I’d always been serious, romantic, tightly wound. Maybe I was just living these things in my own way. Anyway, in the end, what can you do? !e summer got late, and then later. One day while I was stopped at an intersection in my mom’s car a song came on the radio, with a gravelly voiced man singing about how “I hope I was everything I was supposed to be.” As the light turned green, a guy in the oncoming lane leaned his head out of his window and shouted, “Don’t cry!” But it didn’t matter. Days passed, I &nished up at work, Sarah went o" to college in Iowa, and a few days later my time came too.

REED COLLEGE SITS in a neighborhood of one- and two- story houses in the southeast quadrant of Portland, Oregon. Architecturally, the campus presents a jumbled mix of stately collegiate Gothic buildings and angular 1970s a"ordabilia. At the top of a hill rising East there’s a Safeway and a discount store, a bar and a restaurant, a post o'ce and a Plaid Pantry. !ere is nothing dis- tinguished about the area, but I loved Portland from the moment I set eyes on it. Douglas &rs rose from the hilltops, giving the whole city the look of an Alpine theme park, and the air felt fresh and energized, scrubbed clean by its trip across the Paci&c. On a clear day I could catch sight of the distant, snowy mass of Mount Hood, poking from the horizon like a giant’s chipped tooth. At the beginning of freshman orientation week, my father helped me move into my new room. He made a few runs to the store with me for things like coat hangers and laundry detergent, gave me a big hug, and then he was gone. What was it I had been so afraid would happen? After a few

THE DIAGNOSIS 7

Zoloft_i_xxiv_1_312_4p.indd 7 3/21/12 4:22 PM nights, I could hardly remember. From the moment I set foot in Portland, my mood had turned around with a speed and deci- siveness that shocked me. !e transformation was so swift that it was almost embarrassing, the edi&ce of gloom I’d built with such painstaking care all summer tumbling down %imsily under the &rst volley of new people and new things. For the &rst week at school I ricocheted around the campus like an atomic particle: meeting, bonding, splitting, repeating, releasing energy in all directions. I found a girl to go thrift- shopping with on Eighty-Second Avenue. I met Darlene and Rob, who had been friends together in high school in Arizona. A boy from a nearby hall got a crush on me, but I wasn’t interested. I got a crush on a senior who played the cello, but it didn’t last. Some people from my dorm and I went to a party up the street, at a punk house with a keg in the backyard and a kitchen decorated with six- foot- tall signs salvaged or stolen from the meat department of a supermarket. A reddish stop- motion &lmstrip of a seed sprouting into a plant projected in a loop on the bathroom wall while a four- piece rock band played loud in the living room. On the third day, I was &ddling with the combination dial on my student mailbox when I bumped elbows with a girl who was doing the same thing. She smiled and shook her head. “How do you work these damn things?” she asked. I said I didn’t know either. “I’m Kate,” said the girl, stretching out her hand. “I guess your box is right above mine.” Kate had long, deep red hair, straight bangs, and a trace of Texas in her voice. !e moment I looked into her kind hazel eyes, I felt sure that of all the people I’d talked to, this one was going to be a friend. “I’m Katherine,” I said. “Hey— do you want to go to the Para- dox and get some co"ee?”

8 COMING OF AGE ON ZOLOFT

Zoloft_i_xxiv_1_312_4p.indd 8 3/21/12 4:22 PM “Okay.” It was that easy. How could I have fretted so much about ever &nding human connection? One could no more avoid it than step in between raindrops.

THROUGH KATE, I met everyone else who mattered. She lived in the oldest building on campus, a beautiful Gothic dorm shot through by a crazy system of hallways that reminded me of the tunnels in an ant farm. I began to spend most of my free time there, with Kate, her hall mates, or the boys who lived in a triple nearby. Classes started, and freshmen began to troop together in large packs to weekday- morning lectures. We talked about them af- terwards, and about our professors, picking apart their foibles the way people pick apart celebrities. !e shared excitement felt good. I had never been in a place where knowing things wasn’t at least potentially a liability. In high school there had been little pockets where being engaged in what you were studying was an asset, something that could bring you closer to other people rather than marking you o" as strange. But this was a whole new league of play, and I began to want nothing more than to rise and distin- guish myself in it. I felt so relieved to realize that I hadn’t been wrong about Reed. I liked it as much now that I was there as I had thought I would on college night in the high school gymna- sium the year before. A couple of weeks in, I made friends with one of the boys from the triple. Brendan had curly brown hair that grazed his shoulders, and he wore perfectly rumpled white button- down shirts. He had gone to boarding school, which meant that he’d skipped right over the homesickness part of college and already had considerable experience having fun in an institutional set- ting. Most evenings he held court in Kate’s social room, talking

THE DIAGNOSIS 9

Zoloft_i_xxiv_1_312_4p.indd 9 3/21/12 4:22 PM and spinning stories for anyone who passed by, his loud, bleat- ing laugh bouncing o" the walls and reverberating in the next hall over. He dressed up like F. Scott Fitzgerald for Hallow- een, claimed to know what brand of cigarettes Kurt Vonnegut smoked, and promptly worked out &ve ways to get onto the roof of the building. He thought I was funny, and I found him completely enthralling. Brendan quickly became the person on campus I most hoped to run into, the one for whom my eyes scanned the quad and the student union with the greatest diligence. He had a college radio show on Saturday mornings, and I used to get up early and sit with him while he was on the air. !e studio was just a room in the basement of one of the dorms, furnished with a couch whose arms had been rendered hard and shiny from years of rubbed- in food and hand oils. But when I sank into its cushions and listened to Brendan play the oddities he’d harvested from the station’s groaning shelves of records, I couldn’t imagine a place in the world I’d rather be. !e fonder I grew of Brendan, the more I realized that not all of my friends saw him the same way. Ted said that Brendan had teased him ruthlessly while he, Ted, was high and Brendan wasn’t. Jessica said that Brendan seemed smarmy, but I couldn’t understand what she was talking about. Brendan was amazing. Being around him felt amazing. I wanted to be with him all the time. I had a desperate crush on him, of course, but there was more to it than that. I wanted to be like him. !e things about myself that I wasn’t so sure about— the seriousness, the delib- eration, the tendency to worry— were nowhere evident in him. Where some people saw arrogance, I saw a boy who was carefree,

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Zoloft_i_xxiv_1_312_4p.indd 10 3/21/12 4:22 PM at home in the world and in his skin in a way that I would have given almost anything to be. Midterms came, a week of intensely concentrated stress but also a bleary- eyed camaraderie that a"ected the whole campus and made the time pleasant in its own delirious way. I’d stay in the computer labs until two or three in the morning, with Kate or whomever, working on papers under %uorescent light until our minds went swimming in the undersea murals of seaweed and turtles and &sh to which some campus wag had added stumpy cigarettes and thick- rimmed glasses in precise black Sharpie marker. On one of the nights of the reading period, I took a study break with Brendan. We walked to the far end of campus and sat on a log in the undergrowth behind the theater building. We were on the log, and then we were o" it, rolling around in the ivy, kissing frantically. I took my glasses o" and, after a few minutes, realized that I couldn’t &nd them. I began patting down the brush all around us, casually at &rst, then wildly. Bren- dan sat on his heels and watched impassively until I pulled them out of the vines—a rudeness that registered, but not as decisively as I wish it had. On the hall where Brendan lived there was a room so tiny that the residence life o'ce didn’t even assign it to anybody. At one point, Brendan’s hall mates had picked the lock. !ey decorated the space with a bong, some pornographic playing cards, and a few condoms, and dubbed it “the sex room.” A couple of nights after the log incident, I don’t remember quite how, Brendan and I ended up in the sex room. We de&nitely didn’t have sex there, not even close. We fooled around for a while and then fell asleep with our clothes on. By the time I woke up, just after dawn, I

THE DIAGNOSIS 11

Zoloft_i_xxiv_1_312_4p.indd 11 3/21/12 4:22 PM was shivering with cold. Brendan was nowhere to be found, and something felt obscurely but undeniably wrong. When I try to remember the next few days, I get an image of breaking glass: they have that quality of crash and splin- tering. I &nished work, turned in papers, and slept &tfully. I looked for Brendan everywhere, but when I &nally did manage to track him down, he acted as if a stranger had invaded his body. He spoke in monosyllables, as though I were someone he didn’t know, or particularly care to start knowing; he directed his words in the general direction of my face while manag- ing to avoid my eyes completely. He didn’t break up with me or talk about what had happened (what had happened? I felt unsure of anything anymore), but it seemed clear that from his point of view, our friendship, and its whi" of romance too, was decisively and unceremoniously over. I walked away, feeling light- headed. Later someone told me they’d seen him hanging around campus with another girl, whom I knew just vaguely, and who was beautiful. My friends told me I was better o" without him, that there were dozens of worthier guys all around us, but I couldn’t hear them; I felt as if I’d been cut open, my organs removed, and my body &lled with something as hard and heavy as gravel. My last conversation with Brendan happened a day or two before I was supposed to %y home for fall break. I got up early on that Saturday morning and followed the instructions I’d written myself about how to take the bus to the light rail to the airport. I felt tired, hungover, and strangely de%ated. !e past nine weeks had been hectic, I thought, and maybe it was a good idea to take a few days in Arlington to slow down. ______

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Zoloft_i_xxiv_1_312_4p.indd 12 3/21/12 4:22 PM DESCRIBING WHAT COMES next feels unsatisfying any way I try it: I can’t make the facts seem to match up with my reaction, and so it seems that I must be exaggerating or leaving something out. But it happened just like this. My %ight home had a layover in Saint Louis. On the carpet near my gate, I sat in a pool of light that streamed in through big plate- glass windows, and scribbled in my journal. My face was pu"y from crying so much. A di"erent girl would have been furious with Brendan, but I didn’t feel anger, just the sting of rejection, the creeping, hemmed- in sensation of shame. “It looks like you’re writing a ‘Dear John’ letter,” said a voice. I looked up. It was a TWA sta" member in a blue polyester uni- form. She sounded hearty and amused. “A what?” “You know: ‘Dear John, by the time you read this, I’ll be gone . . .’ ” “Oh yeah. Well, I guess I am, kind of.” I tried to enjoy being at home. Fall was usually my favorite season in Virginia. But my mind couldn’t seem to &nd a comfortable position. I felt sad and agitated at the same time. !e happy letters home, dated just weeks earlier, that my parents had taped to the refrigerator door seemed to have been written by someone else—a silly, naive person I didn’t know. One morning, maybe my second at home, I decided to take my mother’s bicycle out for a ride. I wasn’t a frequent rider, but going for a spin seemed like something to do that would get me out of the house, a way to discharge the strange, irritable energy I’d noticed in myself. Soon I was following “*+,- ./01-” signs down sleepy streets that led toward a paved trail. A few brown oak leaves waved, like hands in gloves, high up in a sky of perfect

THE DIAGNOSIS 13

Zoloft_i_xxiv_1_312_4p.indd 13 3/21/12 4:22 PM East Coast blue. I could see that the day was beautiful, but I was still waiting for it to produce in me the happiness that I expected from crystalline October days in Virginia. What I felt instead was that biking seemed harder than I remembered. I could feel my breath ripping unevenly in and out of my chest. I tried to shift down, but the gears seemed to behave exactly the opposite of the way I expected them to, and it got even more di'cult to pedal. I was on familiar streets in a familiar neighborhood less than two miles from my home, but for some reason I began to panic. Or worse than panic: I felt a wave of despair rise, ripple through my body, and escape as heat from the top of my head. My stomach turned over. I didn’t want to be there, and a moment later I knew that I didn’t want to be anywhere. Merely living suddenly just seemed too hard, too undigni&ed. !e burn in my thighs, instead of meaning healthy exercise, felt like an emblem for the pain of life in general, a sickly reminder of every struggle to come. I mounted a small hill, and the gears crunched; the chain went slow and then slower until all my e"ort to push it forward came to nothing. !e wheels ground to a stop and I thought, I can’t do this! I’m so pathetic. I don’t know why I’m even trying. !e bike fell to one side and I got o". Underneath the blue sky, I was dwarfed by oak trees and surrounded by orderly cot- tages on a nice suburban cul- de- sac. In the calm of the middle of a weekday, the surroundings seemed almost creepily indi"erent, like the set of a horror movie. Not far o", the highway rushed softly. I felt a sensation of life speeding away from me on all sides. !e world seemed so distant, so impossible to understand. I saw a pile of mulch, a scrum of bamboo, and clapboard siding. I knew the surroundings were friendly, but felt as out of place as

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Zoloft_i_xxiv_1_312_4p.indd 14 3/21/12 4:22 PM something that had crash- landed on a strange planet. I held the unwieldy bulk of the bike in one hand, and wiped with the other at the tears that were sliding down my face. I tried to calm my breathing and, dizzy with shame, hobbled the bike away from the scene as gingerly as if I had fallen and skinned my knee.

FORTY- F IVE MINUTES AFTER I’d left, I quietly returned home. My mother was standing in the kitchen with her back to me, washing a sink full of dishes. “Oh!” she said cheerfully, turning around. “You’re back soon!” !ough there are few legitimate uses for this English word, I think it would be accurate to say that I wailed as I fell into her soapy arms. “What’s the matter?” she asked, fear spiking her voice up a few notes. She held me back at arm’s length, scanning my body for a visible wound. “I’m sorry,” I said, sni2ing and shaking, teary and confused. She looked me in the eye, and I %inched, as though her face were a %ashlight exposing every hidden imperfection in me. I opened my mouth and blurted out the &rst thing that seemed true. “I just. Really. Don’t like myself right now.” My mother waltz- marched me backward to the gray sectional sofa in the family room. As I remember, I spent most of the rest of the week on that sofa. !e violently bad feelings sub- sided, leaving a residue of dullness and fear. I felt all right when I stayed in my nest, wrapped in afghans and watching TV, but I was terri&ed of what would happen to me when I had to return. It seemed as if all the strength and enthusiasm of the past nine weeks were gone, and I was right back to the worst of where I’d been over the summer, feeling un&t for the world and not up to the everyday tasks other people take in stride. !ese feelings

THE DIAGNOSIS 15

Zoloft_i_xxiv_1_312_4p.indd 15 3/21/12 4:22 PM seemed connected to Brendan, at one end, but they quickly spun o" into something bigger, a dread without boundaries. I won- dered what was happening to me. Was this the same malaise from the summer; had it been lurking for me all this time? Had my nine weeks of happiness at school been real, or were they the deviation, and this awful state my true baseline all along? I wasn’t writing in my journal at the time, so I can’t consult it. Years later, though, I asked my parents what they remembered from my days on the gray sofa, and what they’d made of what was happening then. My mother told me that she’d thought I was heartbroken. She said she knew how badly I had wanted to fall in love, that she’d watched me try and fail back in high school to reap what every song and movie and book for teenagers holds out as the pinnacle of a young life. She had been there when I was in tenth grade and a group of boys that I and another girl were close to had turned away as sharply and ba2ingly as a school of &sh, cutting us o" completely. Maybe she even perceived that there might be, in this recent rejection, an echo of that one, which made it doubly painful. From what little I had told her about Brendan, it was easy for her to imagine that I had been disap- pointed and was taking it hard. And if there was something irrational and over- the- top about my mood that week— well, both she and many of her friends, she said, had breakdowns of one kind or another during college, and went on to lead normal lives. She hated to see me unhappy, but she thought I’d per- severe. Sooner or later something good would happen, and it would bring me up with it. My father took a di"erent view, one that was rooted in his own experience. For most of my life, even before I was sure what

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Zoloft_i_xxiv_1_312_4p.indd 16 3/21/12 4:22 PM the words meant, I had known that my father thought of himself as depressed, or depressive. !e year I was eleven or twelve, he started taking an antidepressant, and I still remember the posi- tive di"erence it made in him, and in the emotional climate of our whole household by extension. Long before the idea gained popular currency, my dad believed that he su"ered from a ge- netically determined tendency to biochemical depression, and the fact that medication worked for him solidi&ed his view that that was the case. And so, where my mother saw a case of teenage Sturm und Drang, my father saw biology asserting itself. He had worried a lot over the years about the possibility that he’d passed the depressive parts of his genetic code on to his daugh- ters, and what was happening to me that year seemed to con&rm his worst fears. When I asked him about it, he remembered that when he’d dropped me o" at campus in August, I looked pale and wobbly. Nine weeks later, he’d seen me walk o" an airplane with tears on my face. What was he supposed to think? !ese two visions made a deeper impression than the perky letters sent in between. He thought I probably needed medicine. And what did I think? I felt close to my dad, but I’d never seriously considered the possibility that I might be depressed in the same way that he was. In high school I’d understood myself to experience mood swings— which went up as well as down, thank you very much— but that seemed like my sovereign teenage right. I didn’t know anyone my age who used antidepressants; medication seemed to belong to a world of grown- up feelings and choices that had nothing to do with me. And maybe that’s the way I wanted it. At some point in high school I had started to think of myself as a writer, an identity that meant to me then, among other things, that feelings were important. Emotion was

THE DIAGNOSIS 17

Zoloft_i_xxiv_1_312_4p.indd 17 3/21/12 4:22 PM the raw material from which everything else was going to proceed, I believed, and anything that might blunt or change mine would have seemed inimical to my vague but dearly- held am- bitions. On the other hand, this new state I was in scared me deeply. College felt like a fast- moving river. !ere was no safe time- out place to crawl into, nothing comparable to the gray sofa at home. I felt like I had to be poised and under control at all times, and I was ready to consider just about any solution that presented itself. Toward the end of the week, my parents and I sat in confer- ence on the deep cushions of the sofa. I remember my mother telling me, half- jokingly, that I didn’t have to go back to college if I didn’t want to. If it was a gambit, it worked: even in my state, I could tell that nothing good would come of brooding on my parents’ couch forever. Instead, the two of them asked me to promise that when I returned, I would immediately make an appointment for myself at the school’s Health and Counseling Center. We agreed they’d get me the help I needed, whatever that turned out to be.

THE PLANE LANDED. I caught a bus back to campus and %ipped on the lights of my dorm room. !e Paci&c Northwest drizzle had begun; it would continue seemingly without end until May. My room didn’t look so homey or exciting anymore, but I was grateful to be able to hang out in Kate’s. Decorated with beeswax church candles and big pieces of fabric, and su"used with Kate’s comfortable and comforting presence, it was the closest thing on campus to an oasis. During those &rst days back, I felt torn between wanting to

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Zoloft_i_xxiv_1_312_4p.indd 18 3/21/12 4:22 PM maintain my dignity and a wish to tell someone what I’d been going through, to try to ask for a little extra patience or care. One night shortly after classes had begun, Kate and I walked across the soccer &eld at the back of the campus, on our way to the Plaid Pantry for study food: Cup O’ Noodles, Slim Jims, or a pint of Häagen- Dazs. Kate asked me how I was, and I chose that dark, soft moment to begin crying again. “Not that good,” I whispered. Saying the words made me feel destabilized. It was like dipping a hand beneath the surface of the fear that seemed to always be there, since just before the start of fall break, like an icy ocean that any casual stimulus— a song, a kind word, a harsh word, it hardly mattered— would plunge me down into, until I lost my breath among the %oes. “Oh darlin’,” said Kate, her Texas drawl the spirit of unfussy compassion. She put her arms around me. I can still see her small hands with their chipped cherry red nail polish. I swabbed at my eyes with the back of my sleeve, feeling silly but relieved— ashamed to be demanding this extra attention but wordlessly grateful for a loving friend.

THE HEALTH CENTER at Reed College is a mossy cottage in an out- of- the- way spot near the center of campus. From the outside, it looks like a building where the heroine in a Brontë novel would live; it has that kind of weedy, wild charm. I had been inside once or twice already to stock up on the free generic medicines they gave out in single- dose paper packets: ibuprofen, aspirin, acet- aminophen, cough drops, and the red nasal- decongestant pills that people took to stay awake while writing papers in these, the years before Adderall. I’d seen the free condoms and lube that

THE DIAGNOSIS 19

Zoloft_i_xxiv_1_312_4p.indd 19 3/21/12 4:22 PM rested in bins decorated cheerily with construction paper and yarn, as though enough kindly wishes on the part of the Health Center sta" could make sex not just physically but emotionally safer too, and the weathered copies of Prevention and the Reed alumni magazine that sagged comfortably, like banana peels, on its waiting room tables. I signed my name and student number into a ledger, and a nurse at the intake window asked me what I was here for. I crowded up, trying to create a seal between myself and the student in line behind me. “Counseling,” I whispered, as softly as I could, then took a seat and waited for what was next. “Katherine?” !e woman calling my name had dark hair and a serious face. She introduced herself as Sam and led me upstairs to a consultation room with a sloping ceiling that reminded me of my childhood bedroom. Sam closed behind us two doors hung in a single frame (“!e rooms are soundproofed for privacy,” she explained) and gestured for me to take a seat in one of two over- stu"ed armchairs. She sat down in the other one, crossed her legs, balanced a pad of paper on her top thigh, and looked at me. I dug my &ngertips into the plushy arms of the chair and looked right back at her. “So,” Sam said. “What brings you here?” I took a deep breath and let it out again. “Where should I start?” “Start wherever feels natural,” she said. “Okay.” My lip trembled, and then I began, %oodgate- style. I told her about the summer, about worrying all the time, about coming to school and feeling better. I told her about the boy and the crush and the bike ride and falling apart and spending

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Zoloft_i_xxiv_1_312_4p.indd 20 3/21/12 4:22 PM a week in a ball on the couch. I told her how a similar thing had happened when I was fourteen and tried to baby- sit for the &rst time, how I’d managed it then by not babysitting anymore, but it didn’t seem so easy just to avoid love and college, did it?! I helped myself to one of Sam’s tissues while she wrote notes down on her little pad. As I watched her hand move across the paper I felt an odd mix of relief and humiliation. Sam guided our conversation to more straightforward things. She asked if I’d been sleeping (yes, to excess); whether I’d been eating (to tell the truth, I didn’t have much of an appetite); whether I was getting my classwork done (sure, classwork was about the only thing I was getting done). She asked me some questions that, even in my state, I could tell were meant to separate the truly crazy people from the merely, well, whatever I was. “Have you ever thought about harming yourself or others?” No. “Do you ever hear things that other people don’t hear?” No! “Do you ever feel like . . .” She paused, just for a beat, as though even she were slightly embar- rassed by the question to come. “Do you ever feel like maybe just not wanting to live anymore?” Oh boy. “Well,” I said carefully. I tried to explain it to her. It wasn’t like I was some kind of suicidal maniac. But were there times lately, in the middle of long prickly afternoons, when it occurred to me what a relief it might be if there were a way to simply not, you know, exist? Yeah, there were times like that. “In psychiatric circles,” said Sam, “that’s what we call passive thoughts of death.” She asked me about my family, and I told her about how my father was still taking his antidepressant faithfully. I told her about

THE DIAGNOSIS 21

Zoloft_i_xxiv_1_312_4p.indd 21 3/21/12 4:22 PM my sister, still in high school, and her new group of troubled- seeming friends. I told her about my mom’s propensity to worry, and the stories I’d heard about the time when my grandmother took to her bed for a week, issuing instructions to her children about how to make their own breakfasts. Sam nodded, smoothed a piece of dark brown hair behind her ear, and looked at me again. !en she reached for another, smaller pad from the desk behind her. “I think you have depression,” she said carefully. “I’m going to write you a prescription for Zoloft. I’m also going to go down- stairs and &nd some samples so you can get started right now.” She left the room. I looked at the clock; we’d been talking for about twenty minutes. I felt like an eggshell, a brittle teacup. I felt like she’d told me to sit still and wait because it was her professional opinion that if I made a move in any direction I might break into a million pieces. “Right now!” "at’s how bad she thought it was, I told myself. Zoloft. Oh, god. I imagined a heavenly tattoo needle coming down from space to etch the scarlet letter D right into my skin.

SAM RETURNED TO the room with &ve or six small cardboard boxes printed in blue, green, and white: free samples of Zoloft. She thrust them into my hands, and I put them in my messenger bag, where for the rest of the day, the tiny pills rattled around in their bottles like dried beans. !at evening I locked the door of my side of the dorm room, took out the boxes, and opened one. Out slid a plastic vial and

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Zoloft_i_xxiv_1_312_4p.indd 22 3/21/12 4:22 PM a tissue- thin sheet of patient information, folded in a tight crimp. It had a diagram of the Zoloft molecule and a section on “pharmacokinetics.” !e pills themselves were sky blue, capsule shaped, lovely. I knocked one into the palm of my hand, tilted my head back, swallowed, and waited.

THE DIAGNOSIS 23

Zoloft_i_xxiv_1_312_4p.indd 23 3/21/12 4:22 PM Zoloft_i_xxiv_1_312_4p.indd 24 3/21/12 4:22 PM